the most common sustained cardiac rhythm disturbance
The 4 pulmonary veins (PVs) are the most frequent location of the ectopic foci that cause AF.
Cardiac tissue (myocardial sleeves) extends into the PVs and normally functions like a sphincter to reduce reflux of blood into the PVs during atrial systole.
AF with rapid ventricular response --> LV systolic dysfunction = tachycardia-mediated cardiomyopathy
Atrial flutter - e Image used on license from Dr Smith, University of Minnesota
Slow the rate, then anticoagulate (if CHADS score >1)
Young man with AF, no TIA or risk factors, no treatment is now preferred to aspirin
Heparin is not necessary prior to starting oral anticoagulants
Heparin is not necessary before starting a patient on warfarin, unless there is a current clot in the atrium.
Cardioversion is only useful for acute unstable cases. It can prevent deterioration into VT/VF.
Because AF is caused by anatomic cardiac defects dilating the atrium, >90% will revert to fibrillation even with the use of antiarrhytmics.
So, DC shock is not routinely performed.
If >48 hours, left atrial appendage thrombus can be developed and high risk of systemic thromboembolism.
Thus, rate control with 3-4 weeks of anticoagulation is recommended before cardioversion is attempted for those patients.